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DICKSON
Step 1 - Bill To:
Name
Company
Address
City
State Zip
Phone ( ) –
Email
Step 2 - Ship To (if different than above)
Name
Company
Address
City
State Zip
Phone ( ) –
Email
Step 3 - Ordering Information
Order # Quantity Price/Unit Total
$ /each $
$ /each $
$ /each $
$ /each $
Subtotal: $
In Illinois, add 7.5% sales tax 4 Tax: $
Freight: $
All Prices in U.S. Dollars 4 Total: $
Step 4 - Payment Method
Check: Check #
Money Order
Credit Card:
Credit Card Number: Expires: (mm/yy)
– – – /
Signature
Purchase Order: P.O.# (Net 15 days for established customers)
Customer #:
U.S.A. Freight Charges
Fax to: 1-800-676-0498 Mail to: Dickson, 930 S. Westwood Ave, Addison, IL 60101
Total Order UPS 2nd Day UPS Next UPSGround
$0-100 $15 $31 $9
$101-400 $19 $39 $14
$401-700 $26 $53 $17
$701-1,000 $35 $56 $24
$1,001-1,500 $52 $72 $36
$1,501-2,000 $69 $91 $43
$2,001-over Please call Dickson Customer Service
All shipments UPS 2nd day unless otherwise requested.